Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond (Edwards, Kendler); Center for Primary Health Care Research, Lund University, Malmö, Sweden (Ohlsson, Jan Sundquist, Kristina Sundquist); and Icahn School of Medicine at Mount Sinai, New York (Kristina Sundquist).
Am J Psychiatry. 2020 Jul 1;177(7):627-634. doi: 10.1176/appi.ajp.2019.19070673. Epub 2020 Mar 12.
The authors examined the association between alcohol use disorder (AUD) and risk of suicide, before and after accounting for psychiatric comorbidity, and assessed the extent to which the observed association is due to a potentially causal mechanism or genetic and familial environmental confounding factors that increase risk for both.
Longitudinal population-wide Swedish medical, criminal, and pharmacy registries were used to evaluate the risk of death by suicide as a function of AUD history. Analyses employed prospective cohort and co-relative designs, including data on 2,229,880 native Swedes born between 1950 and 1970 and observed from age 15 until 2012.
The lifetime rate of suicide during the observation period was 3.54% for women and 3.94% for men with AUD, compared with 0.29% and 0.76% of women and men, respectively, without AUD. In adjusted analyses, AUD remained robustly associated with suicide: hazard ratios across observation periods ranged from 2.61 to 128.0 among women and from 2.44 to 28.0 among men. Co-relative analyses indicated that familial confounding accounted for some, but not all, of the observed association. A substantial and potentially causal relationship remained after accounting for a history of other psychiatric diagnoses.
AUD is a potent risk factor for suicide, with a substantial association persisting after accounting for confounding factors. These findings underscore the impact of AUD on suicide risk, even in the context of other mental illness, and implicate the time frame shortly after a medical or criminal AUD registration as critical for efforts to reduce alcohol-related suicide.
本研究旨在探讨在考虑精神共病的情况下，酒精使用障碍（AUD）与自杀风险之间的关联，并评估观察到的关联在多大程度上归因于潜在的因果机制或遗传和家庭环境混杂因素，这些因素会增加两者的风险。
使用瑞典全人群的医疗、刑事和药房登记处的纵向数据，评估了 AUD 史与自杀死亡风险之间的关系。分析采用前瞻性队列和相对设计，包括 1950 年至 1970 年间出生的 2229880 名瑞典本地人数据，观察时间从 15 岁持续到 2012 年。
在观察期间，患有 AUD 的女性和男性的自杀终生发生率分别为 3.54%和 3.94%，而没有 AUD 的女性和男性的自杀终生发生率分别为 0.29%和 0.76%。在调整分析中，AUD 与自杀仍呈显著相关：女性在各个观察期的风险比范围为 2.61 至 128.0，男性为 2.44 至 28.0。相对分析表明，家族混杂因素解释了观察到的部分关联，但不是全部。在考虑到其他精神科诊断史后，仍存在实质性且潜在因果关系。
AUD 是自杀的一个强有力的危险因素，即使在存在其他精神疾病的情况下，这种关联仍然存在。这些发现强调了 AUD 对自杀风险的影响，即使在其他精神疾病的背景下，也暗示了在医疗或刑事 AUD 登记后不久的时间段内，对于减少与酒精相关的自杀风险至关重要。
